Bryan Christopher F, Cherikh Wida S, Cheng Yulin, Aeder Mark I, Muruve Nicolas A, Nelson Paul W, Shield Charles F, Warady Bradley A, Winklhofer Franz T
Midwest Transplant Network, Westwood, KS, USA.
Clin Transplant. 2004;18 Suppl 12:55-60. doi: 10.1111/j.1399-0012.2004.00219.x.
National sharing of HLA zero-mismatched kidneys has improved long-term graft survival. The distribution of those HLA-matched kidneys by ABO blood group, however, has not been examined. Utilizing the UNOS/OPTN (United Network for Organ Sharing/Organ Procurement Transplantation Network) database, we analysed 112 971 kidney waiting list registrations added during 6/3/95-31/12/00, and 8162 HLA zero-mismatched (0 mm) primary kidney transplants in the USA during 1/1/88-31/3/02. We also analyzed A isoagglutinin titer histories for 87 blood group B end stage renal disease (ESRD) patients for whom at least 1 yr of testing was done. Blood group A patients received 40.1% of the HLA-0 mm kidneys while having a 26.5% representation on the national waiting list. Blood group B patients comprised 17.4% of the waiting list, but received only 10.4% of the HLA-0 mm kidneys. Most (89.6%) blood group B patients awaiting kidney transplantation have low levels of A isoagglutinins, making them eligible to receive a blood group A(2) kidney transplant. The national HLA-0 mm kidney allocation sharing system's imbalance by ABO blood group could be partially resolved in the future by allocating HLA-0 mm blood group A(2) kidneys to B patients.
全国范围内HLA零错配肾脏的共享提高了长期移植肾存活率。然而，这些HLA匹配肾脏按ABO血型的分布情况尚未得到研究。利用器官共享联合网络/器官获取与移植网络（UNOS/OPTN）数据库，我们分析了1995年6月3日至2000年12月31日期间新增的112971例肾脏等待名单登记信息，以及1988年1月1日至2002年3月31日期间美国8162例HLA零错配（0mm）的初次肾移植病例。我们还分析了87例B血型终末期肾病（ESRD）患者的A凝集素滴度历史，这些患者至少接受了1年的检测。A血型患者接受了40.1%的HLA-0mm肾脏，而在全国等待名单上的占比为26.5%。B血型患者占等待名单的17.4%，但仅接受了10.4%的HLA-0mm肾脏。大多数（89.6%）等待肾移植的B血型患者A凝集素水平较低，这使他们有资格接受A（2）血型肾脏移植。未来，通过将HLA-0mm的A（2）血型肾脏分配给B血型患者，全国HLA-0mm肾脏分配共享系统中ABO血型的不平衡情况可能会得到部分解决。
